Developing a set of key measures for perioperative care processes and structures using an adapted COMET approach

Why this work was needed

Perioperative care covers the whole surgical journey – from the decision to operate through to recovery – for each of the millions of NHS patients in England who undergo surgical procedures every year.

It depends on multiple teams, tasks, resources, and handovers working well together. Quality is important to every part of the journey.

Assessing quality requires reliable quality indicators, to support measurement of whether care is safe, effective, and centred on what matters to patients. But existing approaches have often produced long lists of measures that are hard to use, may not reflect patient priorities, and can add burden without necessarily supporting improvement.

Research into perioperative care quality

We carried out a multi-phase study to develop and prioritise indicators of perioperative care quality. We started with a systematic review (a summary of existing research that helps to answer specific questions and identify gaps in the literature) that identified 615 candidate indicators and used the findings to link the indicators to P-Frame, a new 10-domain framework for assessing quality and safety in perioperative structures and processes.

More than 250 stakeholders, including patients, carers and healthcare professionals, took part in several rounds of surveys to help improve and prioritise the indicators. A final consensus workshop involving 26 participants then reviewed the priorities and agreed a final set of 56 indicators. This resulted in:

• 28 core indicators
• 28 desirable indicators

The P-Frame

The P-Frame provides a consistent way of thinking about perioperative quality which considers multiple domains, rather than treating individual indicators as isolated measures. This helps to make sure that the final set reflects the breadth of what matters in perioperative care, including the systems, environments, communication, coordination, and processes that shape patient experience and outcomes.

The study, which involved collaborators at University College London and RAND Europe, is novel in both its product and its method. It uses an adaptation of COMET (Core Outcome Measures in Effectiveness Trials) methodology – a standardised, participatory approach used to determine a core set of items that should be measured and reported as a minimum in a specific area of healthcare. It also embeds patient, carer and professional perspectives throughout, rather than relying only on expert or professional consensus.

A new set of quality indicators for perioperative care

Our research has produced a new set of quality indicators for perioperative care, designed to help healthcare services better understand, monitor, and improve care for patients undergoing surgery.

It addresses a pressing problem in surgical and anaesthetic care, which is that while hundreds of indicators for measuring perioperative quality exist, many are poorly coordinated, weakly supported by evidence, difficult to use in practice, or insufficiently shaped by the priorities of patients and carers. With more than 250 NHS patients, staff and experts involved in its development, the P-frame will offer a much leaner, more relevant, and focused way of monitoring quality of care in surgery.

The indicator set could also help healthcare organisations identify good practice, spot areas where improvement is needed, and design more meaningful approaches to audit, assurance and quality improvement. Used carefully, the indicators may support a learning system for perioperative care, linking measurement to practical action rather than simply producing more data.

This work is intended as a foundation for further testing and implementation, and the next step will be to explore how feasible and valid the indicators are in clinical and administrative datasets, and how they can be integrated with existing audit, reporting, and improvement systems.

Key takeaways

• The collaboration combined academic improvement science with frontline and national expertise in anaesthesia, perioperative medicine, and patient safety.
• The study developed a core set of structure and process indicators for perioperative care.
• The work used a participatory, evidence-informed approach involving over 250 patients, carers, and healthcare professionals.
• The final set includes 28 core and 28 desirable indicators.
• The indicators are organised using P-Frame, a 10-domain quality framework for perioperative care.
• The methodology may be transferable to other areas where structure and process indicators are needed.

With thanks to the perioperative contributorship group members:

Jugdeep K Dhesi, Abi Dennington-Price, Jennifer Dorey, Zoe Packman, Ravinder Vohra, Zoe Brummell, Carolyn L Johnston, Bob Evans, Michael P W Grocott, Scarlett McNally, Iain Keith Moppett